The study enrolled 647 infants with gastroenteritis and minimal dehydration

For children with mild gastroenteritis and minimal dehydration, initiating diluted apple juice followed by their preferred fluids led to fewer treatment failures vs. electrolyte maintenance solution, according to findings from a study published in JAMA.

Electrolyte maintenance solution is recommended to treat and prevent dehydration in cases of gastroenteritis, a common pediatric condition. Its benefits, however, have not been demonstrated in minimally dehydrated children. Researchers from the University of Calgary and the University of Toronto conducted a randomized, single-blind noninferiority trial to assess whether oral hydration with dilute apple juice/preferred fluids was noninferior to electrolyte maintenance solution in children with mild gastroenteritis.

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Between October and April during 2010–2015, 647 study patients aged 6–60 months with gastroenteritis and minimal dehydration were enrolled. They were randomized to receive either color-matched half-strength apple juice/preferred fluids (n=323) or apple-flavored electrolyte maintenance solution (n=324). Following discharge, the half-strength apple juice/preferred fluids group was given fluids as desired, and the electrolyte maintenance solution group replaced losses with additional solution. The primary outcome was a composite of treatment failure defined by any of the following events occurring within 7 days of enrollment: IV rehydration, hospitalization, subsequent unscheduled physician encounter, protracted symptoms, crossover, and ≥3% weight loss or significant dehydration at in-person follow-up.

A total of 644 children (99.5%) completed follow-up. Researchers found that the children given diluted apple juice experienced less treatment failures than children given electrolyte maintenance solution (16.7% vs. 25.0%; difference –8.3%; P<0.001 for inferiority; P=0.006 for superiority). Also, there were fewer children receiving IV rehydration in the diluted apple juice/preferred fluids group vs. the electrolyte maintenance solution group (2.5% vs. 9.0%; difference -6.5%). Rates of hospitalization and diarrhea and vomiting frequency did not significantly differ between the groups.

Use of diluted apple juice and preferred fluids as desired may be a suitable alternative to electrolyte maintenance fluids in children with mild gastroenteritis and minimal dehydration in many high-income countries, study authors concluded.